Medical Assistance

Medicaid is a state and federally funded health care plan administered by county job and family services. Medicaid provides health coverage to a number of different groups of people who meet financial requirements.

Ohio’s Medicaid program provides health care coverage to people who meet certain eligibility requirements. Depending on income, insurance status may affect eligibility and some consumers may be required to pay monthly premiums or co-pays.

The Medicaid Consumer Hotline is available to answer general questions at 1-800-324-8680 and is open Monday through Friday 7am to 8pm and Saturday 8am to 5pm EST. For people with hearing problems, the TDD number is 1-800-292-3572. More information about eligibility, covered services and programs can be found by visiting JFS Ohio Medicaid. Applications are available on our website, at our office, or at Ohio DJFS.

Medicaid covers the following individuals who meet eligibility criteria:

Proof of all income (employment, child support, disability, unemployment, etc.

Additional verifications may be requested or required

What happens after I submit my application?

You will receive notification via mail if you are approved or denied.

We are required to determine eligibility within 30 days of your application

Aged, Blind and Disabled

Could I be eligible?

Older Adults and People with Disabilities

Who is covered?

Income and Eligibility Guidelines

Gross Income*

Resources*

Individual

Couple

Individual

Couple

Older Adults (65 or older) & Disabled People (any age)

64% FPL

$611

$1,048

$1500

$2250

* Some eligibility categories have various resource tests. Deductions and exceptions apply. People with higher incomes may have medical expenses deducted from income calculations to "spenddown" to these income levels

Proof of all income (employment, child support, disability, unemployment, etc)

Proof of resources (bank statements, stocks, bonds, IRA, trusts)

Proof of disability (doctor statement, doctor/hospital records)

Social Security award letter

Additional verifications may be requested or required

What happens after I submit my application?

We offer face to face appointments for you or your Authorized Representative Monday/Tuesday and Thursday/Friday from 8 - 11am and 1 - 3pm.

If you cannot come to an appointment during regular business hours, you can file an application at any time and we will contact you to make other arrangements

Disability Medical Assistance

If you are not pregnant, do not have children in your household and are not Aged, Blind or Disabled (per Social Security), you may still be eligible for Medicaid if you believe you are disabled. DMA provides medical assistance to certain low-income Ohioans who are medication dependent and not eligible for Medicaid. Services offered through the DMA Program include coverage for doctor visits and prescription drugs among other services.

Could I be eligible?

Older Adults and People with Disabilities

Who is covered?

Income and Eligibility Guidelines

Gross Income*

Resources*

Individual

Couple

Individual

Couple

Older Adults (65 or older) & Disabled People (any age)

64% FPL

$611

$1,048

$1500

$2250

* Some eligibility categories have various resource tests. Deductions and exceptions apply. People with higher incomes may have medical expenses deducted from income calculations to "spenddown" to these income levels

Proof of all income (employment, child support, disability, unemployment, etc)

Proof of resources (bank statements, stocks, bonds, IRA, trusts)

Proof of disability (doctor statement, doctor/hospital records)

Proof of SSI application and/or status from the Social Security Office

Additional verifications may be requested or required

What happens after I submit my application?

If you cannot come to an appointment during regular appointment times, you can file an application at any time and we will contact you to make other arrangements

To begin the disability determination process, your caseworker will review your medical records and may request additional records from any of your doctors.

After gathering all of your records, your file will be sent to the Ohio Department of Job and Family Services Disability Determination Unit where they will review your file and make a decision about your disability status. There is currently not a specific timeframe provided for this process.

If your case is approved and you are deemed disabled, you maybe eligible for Medicaid.

If your case is deferred, it means ODJFS needs more information to make a decision.

If your case is denied, it means ODJFS has reviewed your records and finds your are not disabled. You are not eligible for Medicaid for people with disabilities.

If you are not satisfied with the decision of ODJFS, you do have State Hearing Rights and may appeal their decision.

Medicare Premium Assistance Program

This program helps people eligible for Medicare who have limited income and assets get help in paying the cost of one or more of the following:

Medicare Premium(s)

Medicare Deductibles

Medicare coinsurance

Help with Medicare Expenses (Medicare Premium Assistance Program) – check out this booklet if you would like to see if you are eligible to have your Medicare premiums paid.

Could I be eligible?

Medicare Premium Assistance Program (MPAP) Levels

Category Name:

Income Eligibility Guidelines

Gross Monthly Income

Individual

Couple

Benefit

Qualified Medicare Beneficiary ( QMB)

100% FPL

$931

$1,261

• Medicare premiums Part A & B• deductibles• co-insurance

Specified Low-Income Medicare Beneficiary (SLMB)

120% FPL

$1,117

$1,513

Medicare Part B premium

Qualified Individual-1 (QI-1)

135% FPL

$1,257

$1,703

Medicare Part B premium

Qualified Working Disabled Individual (QWDI)

200% FPL

$1,862

$2,522

Medicare Part A premium

**The resource limit for all MPAP categories is $6,660 (individual) and $9,900 (couple).**

MPAP applications are processed by a caseworker without a face-to-face appointment.

Your application will be processed within 30 days and you will be notified via mail if you are approved or denied.

Nursing Home and Waiver Services

Nursing Homes/Facilities

The Department of Health certifies nursing facilities for participation in the Medicare and Medicaid programs. A nursing home is licensed to provide accommodations, personal care services and skilled nursing care for individuals who by reason of illness or physical or mental impairment require skilled nursing care and of individuals who require personal care services but not skilled nursing care.

Medicaid Waiver Programs in Ohio

A Medicaid waiver is a program that "waives," or sets aside, certain requirements of Medicaid and is a way that Medicaid can pay for services to keep you in your home so you do not have to move to a long-term care facility or nursing home. You must need the same level of care as people who live in a long-term care facility, and you must meet the income requirements for Medicaid.

There are many factors that determine a person's eligibility for a waiver, such as the type and extent of their disability, the prognosis, and their financial assets. Each waiver provides different types of services.

These programs are designed to provide Medicaid coverage in addition to home health services to individuals who meet the Level of Care required to live in a nursing home, yet remain at home.

Home and Community-Based Services Waivers provide home health care to individuals who wish to stay in their home but otherwise need institutional care. The number of consumers that can be enrolled in a waiver program at any one time is limited.

Income and resources will be evaluated by an Eligibility Referral Specialist

How do I apply?

To apply for Medicaid for an individual going into or currently in a Nursing Facility, complete and submit the following application: (click here)